Best Start Foods - evaluation: annex B - qualitative research

2. Methods

2.1. Research aims and objectives

The overall aim of the research was to explore and understand the experiences of those who had received Best Start Foods (BSFs) and the impact receiving BSFs had on recipients and their families. The research also aimed to provide insight into the perceptions of health professionals and retailers on the impact, scope and administration of the benefit. In particular, the research aimed to establish whether BSFs allowed pregnant women and those with young children to buy healthy foods; whether this was perceived to have contributed towards improved health and wellbeing and whether the benefit can be improved in order to increase its impact on families and improve overall uptake. The research also allowed exploration of awareness and uptake, and the advantages and disadvantages of the payment card system. The research findings will also seek to inform future improvements to BSFs to ensure that it is meeting the principles set out in the Social Security Scotland Charter.

To address the research aims, the Scottish Government outlined objectives for three participant/stakeholder groups: BSFs clients; healthcare professionals who support BSFs clients and retailers whose businesses participate in the BSFs scheme. These are outlined in Table 1 below.

Table 1. Research objectives

Research objectives for interviews with BSFs clients

To explore:

• The perceived impact BSFs had on clients and/or their child(ren)'s health and wellbeing (including any impact on diet, shopping habits, shopping regularity and meal planning)
• The perceived impact BSFs had on clients' household finances
• Any wider impact BSFs had on clients including any reduction in the stigma associated with the former voucher system
• The range of foods clients purchased using BSFs, and the client awareness and views of the range of food and drink available to purchase using BSFs
• Client views on the different BSFs payment amounts and the extent to which they met the cost of nutritious foods for their family (e.g. 5 portions of fruit and vegetables and a pint of milk a day, or instant formula milk)
• Client views and experiences of using the payment card (including: the clarity of guidance for using the card, ease of use in shops and online, ease of access to participating retailers and ease of card administration (e.g. checking balances, replacing lost cards)
• How clients felt about using the payment card including how this compared with the former voucher system or cash payments
• Client experiences of applying for BSFs (including: how clients became aware of BSFs, clarity of eligibility criteria, experience of the application process (including ease and speed), quality of support received (if sought), and quality of communication on application progress and outcome)

Research objectives for interviews with healthcare professionals

To explore:

• The extent to which healthcare professionals felt BSFs had contributed to the health and wellbeing of pregnant women, breastfeeding women, and families with children aged under 3
• Whether healthcare professionals noticed changes in client attitudes or behaviour in relation to healthy eating, food choices and meal planning
• The views of healthcare professionals on the range of foods available with BSFs
• The views of healthcare professionals on the different rates of payment, and their suitability to cover the cost of nutritious foods
• The experiences and views of healthcare professionals on the application process for BSFs (including whether: they make clients aware of BSFs; clients face barriers when making applications; clients receive enough support to make applications; and successful applicants face any issues when using the payment card)

Research objectives for interviews with retailers

To explore retailer views on:

• The implementation of BSFs, including how the payment card compared with the previous voucher scheme and how supported they feel to administer BSFs
• The range of foods available with BSFs
• BSFs previous promotional activities and plans for future BSFs promotional activities

2.2. Research ethics

An application was submitted to NatCen Research Ethics Committee (REC) in Early November 2021. Ethical approval for the research was granted by NatCen REC in late November 2021.

2.3. Research design

To address the research objectives ScotCen conducted 47 in-depth interviews with BSFs clients (n=33), healthcare professionals (n=5) and retailers (n=9).

Interviews took place between 13^th December 2021 and 23^rd February 2022.

2.4. Recruitment

BSF Clients

To ensure that a breadth of experiences were represented in the research, ScotCen sought to recruit a diverse range of BSFs clients in terms of age, ethnicity, employment status, SIMD and geographic location. The research team aimed to capture the views of families who represent the different 'payment' groups; pregnant mothers, those with a child under 1 and those with a child aged 1 or 2. Amongst these families, ScotCen sought to engage key sub-groups of interest including those with larger families, families with a child or parent living with a disability and single parents.

Social Security Scotland's Client Panels^[10] were used to invite BSFs clients to participate in the research. The Client Panels are made up of benefits recipients who responded to Social Security Scotland's Client Survey^[11] and also agreed to be contacted about future research on the social security system. In December 2021, Social Security Scotland sent out invitations to all 708 BSFs clients on the Panel. To increase the diversity of the sample obtained via the Client Panels, an additional 99 invites were sent to the wider database of BSFs clients in January 2022. These were aimed at groups who were underrepresented in the sample, i.e. clients aged 18-24 and clients living in small towns or rural areas. The method of contact used is outlined in Table 2.

The invitation to participate in the research included contact details for the ScotCen research team. This enabled those wishing to participate in the research to express their interest with the research team directly. Once an individual expressed interest, a member of the research team made contact via email and/or telephone to complete a small number of screening questions. Screening questions asked about a client's age, gender, ethnicity, household composition (number of adults and children living in their household), age of children living in their household, and whether anyone living in the household was living with a disability. Clients were also asked about any accessibility needs for participating in an interview. Clients who had completed screening questions were selected for interview based on the sampling criteria agreed at project inception and invited to choose a date and time for interview.

Healthcare professionals

The Scottish Government sent email invitations to three health boards in December 2021 requesting participation in the research. As with BSFs clients, the invitation included contact details for the ScotCen research team to enable those wishing to participate in the research to opt-in. After a slow response to the initial invitation, a reminder email was sent in January 2022 and an additional health board was invited to participate in the research.

Retailers

A range of approaches were utilised to recruit retailers to participate in the research, including:

• Emails and calls to named retailer contacts supplied by the Scottish Government
• Internet searches to identify email and telephone contact details for large and medium sized retailers

2.5. Conducting the research

The interview topic guides were developed in November 2021 in consultation with the Scottish Government.

All interviews were conducted either by telephone or video call (using MS Teams or Zoom). Interviews took place at times and dates which met with the preferences of participants. On the day of a scheduled interview, before the interview began, the interviewer checked that the participant had received and had a chance to read the project information sheet and privacy notice (either electronically or online). Participants were reminded that the interview was confidential and would not affect the benefits or services they received. After the interview, all respondents received a £30 Love2Shop e-voucher as a thank you for giving up their time, and an electronic 'useful contacts' leaflet. With the consent of respondents, all interviews were audio recorded using an encrypted digital recorder and transcribed for ease of analysis. Verbal consent was recorded at the start of each interview.

2.6. Analysis

All transcripts were imported into and coded using NVivo 12, a software package which aids qualitative data analysis. Firstly, the key topics and issues which emerged from the research objectives and the data were identified through familiarisation with transcripts by members of the research team. A draft analytical framework was drawn up by the research team and piloted on the first few transcripts. The analytical framework was then refined after discussions within the wider project team. Once the analytical framework was finalised, each transcript was coded so that all the data on a particular theme could be viewed together.

Through reviewing the coded data, the full range of views and attitudes described by respondents were systematically mapped, and the accounts of different respondents, or groups of respondents, compared and contrasted.

2.7. Participant demographics

Forty-seven people participated in the research; 33 BSFs clients, five healthcare professionals and nine retailers.

BSFs clients

All but three of the BSFs clients self-described as female (Table 3). Participants were aged between 23 and 42 years. Approximately a quarter (n=8) of the BSFs clients described their ethnicity as Black, Asian or minority ethic.

The number of participants from single parent (n=16) and dual parent households (n=17) was almost evenly split, with the number of children in these households ranging from one to five children. Just under one-half (n=14) of households had three or more children. The age of the children ranged from 0 to 19 years.

Approximately one-half (n=16) of participants were from non-working households. Non-working households included: job-seekers; single parents who were caring for their young children; and individuals caring for a partner, child or other family member who was living with a disability or long-term health condition. The remaining households had at least one adult in full or part-time paid employment (n=11) or education (n=6). Approximately half of the households who participated in the research had a parent or child with a disability or long-term health condition (n=16); 12 of whom were in non-working households and four had at least one adult in full or part-time paid employment (n=3) or education (n=1).

BSFs clients lived in urban cities and towns, small towns and rural areas across Scotland. BSFs clients who participated in the research lived in 17 different local authorities in Scotland^[12]. The majority of BSFs clients (n=27) who participated in the research lived in Scottish Index of Multiple Deprivation (SIMD) quintile areas 1 and 2, which represent the most deprived areas of Scotland.

Two thirds of respondents (n=22) received payments for a child or children at different ages. Some participants received BSF for one child at different ages (e.g. 0-1 and 1-3) while others may have had multiple children eligible at different ages (e.g. one 0-1 and another 1-3).

Healthcare professionals

Five healthcare professionals from four health boards participated in an interview. Four were family nurses and one was a health visitor. Participants had been in their current role for between 18 months and 10 years.

Retailers

Nine retailers participated in an interview; two were from large supermarket chains with a national remit with the remaining seven representing smaller retail chains. Retailers from urban and rural locations across Scotland were interviewed.